What is it?

Adenoids are swellings in the back of the nose. You can't see them because they are hidden behind the floppy part of the roof of the mouth. But they are like the tonsils you can see in the back of the throat. They are near the little tubes in the back of the nose which pass to the ears.

The adenoids are made of gland tissue, like the tonsils. This tissue swells up to and harbours many 'defence cells' that help fight infection. Usually the swelling settles down after the infection passes.

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Your child's adenoids are now swollen all the time after many attacks of infection. They are blocking the back of the nose. This makes breathing through the nose difficult. They can also block the tubes in the back of the nose which pass to the ears. Blockage here can cause earache and deafness.

Taking out the adenoids will stop these nose and ear problems. After taking out the adenoids, there is plenty of gland tissue elsewhere in the head and neck, and throughout the body, to fight infection. This condition is not the parents' fault.

The operation

Special instruments are passed into the back of the mouth. The adenoids are freed off and taken away. A special instrument called diathermia (a Greek word which means to apply heat) is usually used which can free the tonsils and adenoids and at the same time can stop the bleeding by applying a wave of heat on the small blood vessels (pipes that carry blood). There are no cuts in the skin.

Because your child will be completely asleep, he or she will not feel any pain at all during the operation.

Your child should be fit to go home the next morning.

Any alternatives?

Usually adenoids shrink away on their own when the child reaches the age of 12 or 13. Waiting this long is not a safe prospect for a child. It may lead to life-long hearing difficulties.

Tablets or medicines will not make the adenoids get smaller or go away.

Before the operation

Sort out any tablets, medicines, inhalers that your child is using. Keep them in their original boxes and packets. Bring them to the hospital with you.

On the ward, your child will be checked for past illnesses and will have special tests to make sure that he or she is well prepared and can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings.

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You and your child will have the operation explained to you and will be asked to fill in an operation consent form.

Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.

Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.

Before the operation and as part of the consent process, you may be asked to give permission for any 'left over' pieces to be used for medical research that have been approved by the hospital. It is entirely up to you to allow this or not.

Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.

If your child has a cold in the week before admission to hospital, please telephone the ward and let the ward sister know. Usually, the operation will have to be postponed. Your child needs to get over the cold before the operation can be done because by having an anaesthetic the cold could turn into a serious infection in the chest.

Because the surgeon will be working inside your child's mouth, you must tell him if your child has any loose teeth.

After – in hospital

Usually the throat is only slightly sore after this operation. The nurses will give your child some medicine (usually painkillers in a syrup form) to help relieve the sore throat. A

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general anaesthetic may make your child slow, clumsy and forgetful for about 24 hours. The nurses will support you to help your child until he or she feels better.

Your child will be able to drink about two to three hours after he or she returns to the ward, and will be eating normally later on in the day.

Before you leave the ward you may be given an appointment card to bring your child back to the ENT (ear, nose and throat) outpatient clinic for a check-up.

Some hospitals arrange a check-up about one month after the operation. Others leave check-ups to the general practitioner.

After – at home

Use paracetamol suspension to settle any sore throat. If possible, try and avoid your child catching a cold or cough within the first week at home. Avoid having friends round to play if they have a cold. For the same reason your child should stay off nursery or school for a week after the operation.

If your child does develop a cold, you should take your child to see your general practitioner for a course of oral antibiotic tablets.

Your child should not go swimming until the throat has healed. This is usually after about three weeks.

Possible complications

As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs.

The tests that your child will have before the operation will make sure that he or she she can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

If you follow the advice given above, your child is unlikely to have any problems. Sometimes (in less than 1 per cent of cases) the surgeon has to control oozing of blood from the adenoid area. This means tucking a length of gauze into the nose for 24 hours or so. When the surgeon is certain that the bleeding has stopped, the gauze is taken out. A second very short operation will be needed to do this.

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Bleeding can also occur a week or so after the operation, usually due to an infection. If an infection is developing your child might also have increasing pain at the area of the operation, a headache or temperature. If this happens, bring your child back to the ward. Your child will probably stay on the ward for a day or two and take antibiotics for one to two weeks.

If the infection is serious (spreads beyond the area of the operation or in the blood) your child might need to have intravenous antibiotics (through a vein in their arm). Another operation is not usually needed.

There is a very small chance (no more than 6 in a 1000) that when the adenoids are removed the area close to where they used to be is not closing properly and this can affect your child's speech. In the majority of cases this can improve with speech therapy and only in a few cases is an operation needed to fix the problem.

General advice

These notes should help you and your child through his operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little.

If you have any queries or problems, please ask the doctors or nurses.

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